[georgie]

Recognition and assessment of coeliac disease

NHS NICE Coeliac Guidelines to UK Drs


Clinical guidelines CG86

Issued: May 2009

How reliable are serological tests compared with intestinal biopsy in detecting early coeliac disease?

− Evidence of the presence of coeliac disease can be suggested by the finding of highly specific and sensitive antibodies to tissue transglutaminase and to endomysium. Confirmation of the presence of intestinal damage revealed by the histological examination of small-intestinal biopsies remains the traditional method of making the diagnosis. The sensitivity of this investigation has rarely, if ever, been formally investigated. With increased use of serological tests for coeliac disease it has become evident that some people with positive coeliac autoantibodies have apparently normal small-intestinal histology. Some such people are, nonetheless, symptomatic and have gluten-sensitive malabsorption. Early detection of coeliac disease may be important to prevent long-term complications, Therefore longitudinal studies are needed to determine whether serological markers are superior and can reliably detect early coeliac disease before intestinal damage occurs.


http://guidance.nice.org.uk/CG86


This is a quick flow chart from the Quick Reference Guide



Does the person have any symptoms in Box A or B

Yes


Is the person on a Gluten containing diet

No

Is the person willing/able to reintroduce Gluten to their diet ?

No

Refer them to a Gastro Specialist and inform them that it may be difficult to confirm a diagnosis on intestinal biopsy , and that this may have implications on their ability to access prescribed gluten-free foods


Box A
Offer serological testing to children and adults with any of the following signs , symptoms and conditions.

Chronic or intermittant diarrhoea
Failure to thrive or faltering growth ( in children)
Prolonged Fatigue ( "tired all the time" )
Recurrent abdominal pain , cramping or distention
Unexplained iron anaemia or other unspecified anaemia

Conditions

Autoimmune Thyroid Disease
Dermititis Herpetiformis
Irritable Bowel Syndrome
Type 1 Diabetes
First degree relatives ( parents, siblings or children ) with Coeliac Disease




Box B
Consider offering serological testing to children and adults with any of the following

Addisons Disease
amenorrhoea
apthous stomatitis ( mouth ulcers)
autoimmune liver conditions
autoimmune myocarditis
chronic Thombocytopenia
dental enamel defects
depression or bipolar disorder
downs syndrome
epilepsy
low trauma fracture
lymphoma
metabolic bone disease
microscopic colitis
persistant or unexplained constipation
persistantly raised liver enzymes with unknown cause
polyneuropathy
recurrent miscarriage
reduced bone mineral density
sarcoidosis
Sjogren's syndrome
Turner syndrome
unexplained alopecia
unexplained subfertility